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DELIRIUM
WHAT’S DELIRIUM???
 Delirium is the most common behavioral disorder in
  a medical-surgical setting. Delirium is an acute
  mental status change characterized by abnormal
  and fluctuating attention
 Delirium may be the only sign of a serious or life
  threatening medical condition and is a common
  manifestation of acute illness among older people
CLINICAL FEATURES
 Acute onset of mental status change with
  fluctuating course
 Attention deficits

 Disorganized thinking

 Altered level of consciousness

 Perceptual disturbances

 Disturbed sleep-wake cycle

 Altered psychomotor activity

 Disorientation and memory impairment

 Other cognitive deficits

 Behavioral and emotional abnormalities
DSM-IV (DIAGNOSTIC CRITERIA FOR
DELIRIUM)
   Disturbance of consciousness (i.e., reduced clarity of
    awareness of the environment) with reduced ability to
    focus, sustain, or shift attention.
   A change in cognition (such as memory deficit,
    disorientation, language disturbance) or the
    development of a perceptual disturbance that is not
    better accounted for by pre-existing, established, or
    evolving dementia.
   The disturbance develops over a short period (usually
    hours to days) and tends to fluctuate during the course
    of the day.
   There is evidence from the history, physical
    examination, or laboratory findings that the disturbance
    is caused by the direct physiological consequences of a
    general medical condition.
CONFUSION ASSESSMENT METHOD (CAM)
 1. Acute onset and fluctuating course (mental status
  changes from hours to days)
 2. Difficulty in focusing (easily distracted, unable to
  follow interview)
 3. Disorganized thinking (rambling, irrelevant
  conversation)
 4. Altered level of consciousness (from hyper alert
  to decreased arousal)
 A positive CAM test for delirium requires items 1
  and 2 plus either item 3 or item 4).
Delirium

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Delirium

  • 2. WHAT’S DELIRIUM???  Delirium is the most common behavioral disorder in a medical-surgical setting. Delirium is an acute mental status change characterized by abnormal and fluctuating attention  Delirium may be the only sign of a serious or life threatening medical condition and is a common manifestation of acute illness among older people
  • 3. CLINICAL FEATURES  Acute onset of mental status change with fluctuating course  Attention deficits  Disorganized thinking  Altered level of consciousness  Perceptual disturbances  Disturbed sleep-wake cycle  Altered psychomotor activity  Disorientation and memory impairment  Other cognitive deficits  Behavioral and emotional abnormalities
  • 4. DSM-IV (DIAGNOSTIC CRITERIA FOR DELIRIUM)  Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.  A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by pre-existing, established, or evolving dementia.  The disturbance develops over a short period (usually hours to days) and tends to fluctuate during the course of the day.  There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition.
  • 5. CONFUSION ASSESSMENT METHOD (CAM)  1. Acute onset and fluctuating course (mental status changes from hours to days)  2. Difficulty in focusing (easily distracted, unable to follow interview)  3. Disorganized thinking (rambling, irrelevant conversation)  4. Altered level of consciousness (from hyper alert to decreased arousal)  A positive CAM test for delirium requires items 1 and 2 plus either item 3 or item 4).